Reinke’s Space (Superficial Lamina Propria)
Layer just underneath the surface lining of the vocal fold; composed of cells, special fibers, and other substances (extracellular matrix); has key role in vocal fold vibration

“Stripping”
A “radical” surgical procedure that removes (“strips”) the top layers of the vocal folds resulting in severe vocal fold scarring and abnormal voice. Due to the resultant damage, this procedure is at present rarely used

In Brief
Voice disorders can result from the swelling of the non-muscle part of the vocal fold that is right underneath its surface lining (i.e., in the superficial lamina propria, also known as Reinke’s space). This condition is called Reinke’s edema, which literally means “swelling in Reinke’s space” or “build-up of fluid in Reinke’s space.”

Common Complaints
Patients usually have a low, raspy, or rough voice. A low voice is particularly striking in women – a male-quality voice in a female.

Common Causes
Reinke’s edema is caused by vocal fold irritation from voice misuse, smoking, and/or conditions that irritate the vocal folds, such as backflow of stomach fluids to the voice box (laryngopharyngeal reflux). Reinke’s edema typically occurs in middle-aged/post-menopausal women who have a long-term history of smoking cigarettes.

Treatment Strategies
Reinke’s edema does not go away on its own.

The cause of Reinke’s edema needs to be identified and treated before treatments directed at the voice disorder (such as voice therapy or surgery) are considered.

Typical Course
Although Reinke’s edema usually develops slowly over the course of many years, the condition can worsen to the point of causing problems with breathing (airway problems).
Red Flag
Any and all airway problems require immediate attention.

Red Flag
According to current best practices, there is no role for “vocal cord/vocal fold stripping” in treating Reinke’s edema. “Vocal cord/vocal fold stripping” refers to the removal of vocal fold epithelium using microcup forceps. This procedure results in excessive vocal fold scarring.
If primary causes, such as smoking or reflux, are not addressed, Reinke’s edema will recur.

Advisory Note

Patient education material presented here does not substitute for medical consultation or examination, nor is this material intended to provide advice on the medical treatment appropriate to any specific circumstances.